Topical mitomycin-C versus subconjunctival 5-Fluorouracil for management of bleb failure

To compare the efficacy and safety of topical mitomycin C [MMC] drops with that of subconjunctival 5-fluorouracil [5-FU] injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation [PT+PCIOL]. In a randomized comparative study, 37 eyes of 37 patients with impending early bleb failure received MMC 0.02% eye drops for 2 or 4 weeks [19 eyes] or subconjunctival 5-FU injections, 5 mg per dose [18 eyes]. Complete success was defined as 5 < IOP

Peripapillary retinal nerve fiber layer thickness measurement by three-dimensional optical coherence tomography in a normal population

To determine peripapillary retinal nerve fiber layer [RNFL] thickness values by three-dimensional optical coherence tomography [3D-OCT] in a normal Iranian population and to evaluate the concordance of these measurements with those obtained by the second generation of optical coherence tomography [OCTII]. In a cross-sectional observational study, 96 normal Iranian subjects 20-53 years old were enrolled. Peripapillary RNFL thickness in one randomly selected eye of each subject was measured by 3D-OCT and also by OCT II. Standard achromatic perimetry, corneal pachymetry and A-scan ultrasonographic biometry were also performed. Other study variables included age, gender, laterality [right versus left eye], refractive error, corneal diameter and disc area. Mean peripapillary RNFL thickness measured by 3D-OCT [75.50 +/- 8.38] micro m was significantly less than that measured by OCT II [144.10 +/- 33.32 pn] [P<0.001]. Using 3D-OCT, no significant difference in peripapillary RNFL thickness was observed by gender [P=0.90] or laterality [P=0.17]; RNFL thickness had no correlation with age [P=0.95], axial length [P=0.32], spherical equivalent refractive error [P=0.21], central corneal thickness [P=0.66] and disc area [P=0.31]. However, a positive correlation was found between peripapillary RNFL thickness and corneal diameter [P=0.03]. 3D-OCT seems to yield lower RNFL thickness values as compared to OCT II. It seems advisable to obtain separate baseline measurements when using different generations of OCT machines

Radiation chiasma neuropathy after radiotherapy for treatment of paranasal sinus lymphoma

To present a patient with radiation chiasma neuropathy, secondary to radiotherapy of paranasal sinus lymphoma who was referred for evaluation of gradual decrease of vision in both eyes. The patient was a 38-year-old male, with history of right maxillary sinus lymphoma, who underwent surgery, chemotherapy and radiation therapy. One year after radiotherapy, he noticed gradal decrease in his right eye vision. He referred to our center 6 months after onset of visual symptoms [1.5 years after radiotherapy]. On his first examination, visual acuity [VA] of right eye was no light perception [NLP], and right optic disc was severely atrophic. Other examinations of right eye were unremarkable. The VA of left eye was 10/10 with correction, color vision was normal, slit lamp exam and tonometry was normal as well, but bow tie atrophy of left optic disc was detected. Visual field of left eye revealed temporal hemianopia. MRI showed thickening and enhancement of optic chiasm, especially in right side. In follow-up the enhanced lesion enlarged posteriorly and involved both optic tracts and optic radiations. In spite of treatment with high dose corticosteroid and hyperbaric oxygen, within two years following radiotherapy, vision of left eye gradually decreased to NLP too. Radiation-induced optic neuropathy is an important differential diagnosis of decreased vision in a case with history of head and neck radiotherapy. Since this complication is very important with ominous consequence, ophthalmologists and radiotherapists should be aware of that; and decrease the chance of its occurrence by lowering the dosage, daily fractionation, stereotactic methods, and precise aiming of radiation beam

Intravitreal bevacizumab [avastin] injection for neovascular glaucoma

To report two cases with neovascular glaucoma secondary to ischemic central retinal vein occlusion [CRVO] who were treated with intravitreal bevacizumab. Two patients were referred for neovascular glaucoma following CRVO. Visual acuity was light perception. Both eyes had extensive iris neovascularization [NVI], synechial angle closure and high intraocular pressure [IOP] in spite of anti-glaucoma medications. After obtaining informed consent both eye received an intravitreal injection of 2.5 mg [0.1 ml] bevacizumab [Avastin]. Both eyes demonstrated dramatic IOP reduction together with decreased severity and extent of NVI during 4 weeks of follow up. Visual acuity remained unchanged. Despite the dramatic short-term response in terms of IOP reduction and regression of neovascularization, due to limited clinical experience, one should consider this novel indication for bevacizumab cautiously